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Journal of Clinical Microbiology, May 2005, p. 2220-2223, Vol. 43, No. 5
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.5.2220-2223.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Significance of Transiently Positive Enzyme-Linked Immunosorbent Assay Results in Detection of Helicobacter pylori in Stool Samples from Children

Thomas D. Haggerty,1* Sharon Perry,1 Luz Sanchez,1 Guillermo Perez-Perez,2 and Julie Parsonnet1,3

Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California,1 Division of Infectious Diseases, Departments of Medicine and Microbiology, New York University School of Medicine, New York, New York,2 Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, California3

Received 12 November 2004/ Returned for modification 1 January 2005/ Accepted 18 January 2005

In young children, the significance of stool samples transiently positive for Helicobacter pylori antigen is unknown. As part of a larger prospective study on enteric infections, stool samples were obtained from 323 children at two time points 3 months apart and tested for H. pylori antigen using a commercially available enzyme-linked immunosorbent assay (ELISA) test. Seminested PCR for a Helicobacter-specific 16S rRNA gene was performed on all 26 pairs reverting from positive to negative (transient positives), all 4 persistent antigen-positive pairs, and 10 randomly selected persistent antigen-negative pairs. Helicobacter species were amplified from the first stool samples of 15/26 (58%) of the transient positives and 1 (25%) of 4 persistent positives. No Helicobacter species were amplified from the 10 persistent negatives. Among the 15 amplicons from transient-positive stool, H. pylori was sequenced and identified from 12 (80%; 95% confidence interval, 52% to 96%) and other Helicobacter spp. were identified from three (Helicobacter canis, Helicobacter winghamensis, and MIT 99-5504). Four of the 15 remained positive by PCR for the second (antigen-negative) stool sample, including all 3 initially identified as non-H. pylori. Helicobacter bilis was amplified from the second sample of a persistent positive. Two of eight transient positives from whom serum was available had accompanying transient elevations in anti-H. pylori antibodies. Transiently positive stool ELISAs for H. pylori are common and represent H. pylori in the majority of cases where sequences can be obtained. A not-insignificant percentage of antigen-positive stools, however, may represent other Helicobacter species.

* Corresponding author. Mailing address: Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, 300 Pasteur Dr., Stanford, CA 94305-5107. Phone: (650) 725-7511. Fax: (650) 725-3584. E-mail: tdhaggerty{at}stanford.edu.

Journal of Clinical Microbiology, May 2005, p. 2220-2223, Vol. 43, No. 5
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.5.2220-2223.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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